In here, we are going to be providing you with all you need to know about puerperium and it’s occurrence.
Puerperium occurs as involution and it is defined as the return of the mothers reproductive organs to the non-pregnant state as a result of changes that occur after birth. In this article, we have taken our time to explain the major physiological changes that occurs in the body of the mother during puerperium.
Physiological changes occur at different organs of the body such as the endocrine system, uterus, urinary system, pelvic floor and breast.
1. Changes in the Endocrine System
There is drastic reduction in oestrogen and progesterone which have been blocking the effect of prolactin on milk production.
This will then lead to the activation and more release of prolactin(a hormone secreted by the anterior pituitary gland) into the blood system, hence promotes milk production.
The raised level of prolactin inhibits ovulation and therefore contraceptive function, this is because during lactation there is release of oxytocin from the posterior pituitary gland which helps to suppress ovulation.
Oxytocin causes the myo-epithelial cells around the alveoli to contract and push milk into the lactiferous vessels.
This will in turn delay menstruation and the first menses is usually anovula.
Menstruation with ovulation occurs as early as seven to nine weeks in 70 percent of non-lactating mothers and 24-36 weeks in lactating mothers.
2. Changes in the Uterus
Changes occur inform of involution, which is the return of reproductive organ to its non-pregnant state as a result of changes that occur after birth. Involution occurs in three stages;
Stage of Uterine Contraction;
There is increased uterine contraction to close up the placenta site and give a ligature action to the exposed blood vessels leading to ischaemia.
Stage of Autolysis and Auto Digestion of The Myometrial Wall;
There is autolysis and auo digestion of the myometrial cell due to deoxygenation and ischaemia.
This then causes the upper layer of the endometrium to slough off and is passed out in a menstrual like manner known as lochia. Lochia occurs in three phases;
- Lochia rubra: this consist mainly of red blood cells and occurs within the first two days post partum.
- Lochia serosa: this consist mainly of plasma and white blood cells. This occurs from third to fourth days post partum.
- Lochia alba: this consist of mucous, white blood cells and debris. This occurs from tenth to fourteenth days post partum.
Stage of Epithelia Regeneration;
The epithelial layer of the inner most lining of the endometrium gradually regenerates and is completed by the sixth week post partum.
3. Changes in The Urinary System
There is increase in filtration rate.
The urinary tract is relieved from pressure after delivery, the kidneys secrete actively and the bladder often fills rapidly.
This cause the patient to urinate more frequently, leading to physiological diuresis/puerperal diuresis.
During the first 48 hours of puerperium, there is increased diuresis as a result of reduction in the mothers blood volume and autolysis of uterine muscle fibres.
There maybe urine retention if the bladder has been bruised or has lost its tone following difficult labour. Pain may inhibit the patient from passing urine, in cases where the perineum has been sutured.
The urine may contain albumen, blood and debris if the bladder has been bruised during labour.
4. Changes in The Pelvic Floor
During pregnancy and labour, the pelvic floor muscles undergo many changes as they are greatly distended, bruised, stretched and perhaps lacerated.
The muscles may be flaccid. Within a period of six weeks post partum, the distension, flaccidity, bruises stretching and laceration heals.
Within this period of six weeks, despite the entire changes pelvic floor under went during pregnancy and labour, it returns to its pre-gravid state.
5. Changes in the Breast
The change that occurs in the breast during puerperium is majorly lactation. Lactation is the secretion or production of milk.
Two factors governed by hormones are responsible for the physiology of lactation;
Production of milk (Prolactin action)
Prolactin a hormone secreted by the anterior pituitary gland is essential for the production of breast milk, but although its level in the maternal circulation rises during pregnancy and its action is blocked by the placenta hormones. With the separation and expulsion of the placenta at the end of labour, oestrogen and progesterone level gradually decrease to the point where prolactin can be released and activated.
Passage of milk (oxytocin action)
two factors are involved in the transit of milk from the secretory cells to the nipple;
- Back pressure: the force of new globules forming in the cells pushes the foremost ones into the lactiferous tubules and sucking of the infant stimulates secretion of more milk.
- Neurohormonal reflex (let-down reflex): when the baby is put to the breast, the rhythmical sucking movement produces nervous stimuli which cause an unconditioned reflex in the posterior pituitary gland. This leads to the liberation of oxytocin which causes the myoepithelial cells to contract and push milk into the lactiferous vessels and so kore milk flows to the ampulla.
Possible Problems a Woman May Experience During Puerperium Period
- Puerperal pyrexia.
- Genital tract infection.
- Urinary tract infection.
- Breast engorgement leading to complication such as mastitis.
- After pains.
- Uterine inversion.
- Thrombotic condition e.g thrombophlebitis, phlebothrombosis.
- Post partum haemorrhage.
- Sub-involution.
- Puerperal psychosis.
- Puerperal sepsis.